A lupus diagnosis brings daily challenges, made even more daunting when you are navigating the complex process of securing short and/or long term disability insurance benefits. Dealing with your insurance company while grappling with the debilitating effects of lupus can be an overwhelming and frustrating experience, leaving many claimants feeling lost in a maze of paperwork and bureaucracy.
In this article, we will shed light on the unique hurdles faced by those seeking short and/or long term disability insurance benefits for lupus, as well as what evidence can bolster your claim and how a long term disability lawyer at The Maddox Firm can help.
Can I Get Short or Long Term Disability Benefits for Lupus?
Yes, you may be eligible for both short term and long term disability benefits for lupus, depending on your specific circumstances and the terms of your disability insurance policy. Lupus is a chronic autoimmune disease that can cause a range of symptoms and complications, making it difficult for some individuals to maintain regular employment.
Short term disability benefits: If you are covered by short term disability insurance, it can provide you with financial support for a limited period, typically a few weeks to a few months, depending on the policy. During a lupus flare-up or when you are undergoing treatment and unable to work, short term disability benefits can replace a percentage of your lost income. The duration of short term disability benefits varies depending on the specific policy and the severity of your condition.
Long term disability benefits: If your Lupus symptoms and limitations persist beyond the duration of short term disability coverage, long term disability benefits may be applicable. Long term disability insurance is designed to provide income replacement for an extended period, potentially until you are able to return to work or reach retirement age, depending on the terms of the policy.
To qualify for disability insurance benefits, you typically need to demonstrate that your lupus symptoms significantly impair your ability to perform your job duties, and that you meet the definition of “disability” as outlined in your policy. It’s essential to carefully review the terms and conditions of your disability insurance policy, as each policy may have different requirements and coverage details. Additionally, some policies may have a waiting period before benefits kick in, so it’s crucial to be aware of these details and plan accordingly.
If you’re considering applying for disability benefits for lupus, it’s recommended to consult a reputable long term disability attorney who can guide you through the application process and ensure you provide the necessary information to support your claim.
How Does Lupus Cause Disability?
Lupus can cause disability due to its nature as a chronic autoimmune disease that affects multiple organs and systems in the body. The immune system, which defends the body against infections and illnesses, becomes hyperactive and attacks healthy tissues instead. This ongoing immune response can lead to inflammation, tissue damage, and a variety of symptoms that can significantly impact your ability to function and work.
Here are some ways Lupus can cause disability:
Fatigue: One of the most common and debilitating symptoms of lupus is extreme fatigue. This fatigue can be overwhelming and persistent, making it difficult for you to carry out daily activities, including work-related tasks.
Joint and muscle pain: Lupus can cause joint pain, swelling, and stiffness, which can limit your mobility and ability to perform physical functions related to your job, such as standing, sitting, typing, or writing.
Organ involvement: Lupus can affect various organs such as the skin, kidneys, heart, lungs, and brain. Organ involvement can result in a range of symptoms and complications, such as skin rashes, kidney problems, heart issues, breathing difficulties, and cognitive impairments, depending on the affected organ. These symptoms can be severe and significantly impact your ability to work.
Flare-ups: Lupus symptoms often occur in unpredictable flare-ups, where symptoms worsen for a period before subsiding. During flare-ups, you may experience intensified pain, fatigue, and other symptoms, making it challenging to maintain consistent work attendance and productivity.
Reduced immune function: Lupus can weaken the immune system, making you more susceptible to infections and illnesses. Frequent illnesses can lead to increased time off work and reduced productivity.
Cognitive impairment: Lupus can cause cognitive impairment, often referred to as "lupus brain fog” or “central nervous system lupus.” Memory problems, difficulty concentrating, slowed thinking, language difficulties, and problem-solving challenges are some of the cognitive symptoms associated with the disease, affecting up to 80% of those with lupus to varying degrees.
Medication side effects: Some medications used to manage Lupus can have side effects, including nausea, dizziness, and cognitive issues, which can affect your ability to work effectively.
Overall, the combination of physical and cognitive symptoms, unpredictable flare-ups, and potential organ involvement can result in significant disability if you have lupus. The severity of disability varies widely from person to person, depending on the extent of your symptoms and the effectiveness of treatment.
If you are experiencing symptoms that interfere with your ability to work due to lupus and need to file a short or long term disability claim, you should speak with an experienced disability attorney who can help you through the process.
How Do Insurance Companies Evaluate Lupus Disability Claims?
Filing a lupus disability insurance claim can present unique challenges due to the nature of the disease and the way it affects individuals. Some of the challenges specific to lupus disability insurance claims include:
Subjective nature of symptoms: Lupus symptoms can vary significantly from person to person and can be subjective in nature. Symptoms like fatigue, pain, and cognitive difficulties are challenging to objectively measure, making it more difficult to prove the extent of disability to insurance companies.
Fluctuating symptoms: Lupus symptoms often fluctuate, with periods of remission and flare-ups. During remission, your condition may improve, leading to doubts from your insurance company about the ongoing impact on your ability to work. Conversely, during flare-ups, symptoms can become severe and debilitating, making it challenging to maintain consistent work attendance and productivity.
Lack of visible physical impairment: Lupus is an invisible illness, meaning that you may not have any outward signs of disability or impairment. Insurance companies tend to doubt the severity of disability when there are no visible physical indications.
Lengthy diagnosis process: Lupus can be challenging to diagnose as its symptoms can mimic those of other conditions. You may experience delays in getting an accurate diagnosis, which can complicate the disability claims process.
Coexisting conditions: People with lupus often have other health conditions or complications, such as kidney problems or cardiovascular issues. Determining which conditions are directly related to your disability claim can be complex.
Lack of understanding about lupus: Insurance companies may have limited knowledge about lupus and its impact on your daily life. As a result, they may not fully appreciate the severity of the condition and its effects on your ability to work.
Frequent medical documentation requirements: Insurance companies often require extensive medical documentation to support disability claims. However, the intermittent nature of lupus symptoms may lead to challenges in providing consistent medical evidence of your disability.
Navigating the disability claims process can be complex, but with proper documentation and legal guidance, you can increase your chances of receiving the benefits you are entitled to. A long term disability lawyer experienced in handling lupus claims can greatly improve your chances of a successful claim or appeal.
What Evidence Can I Use to Support My Lupus Disability Claim?
When filing a lupus disability claim, the goal is to demonstrate how your lupus symptoms significantly impair your ability to work and perform daily activities. Your insurance company will require documentation supporting your disability beyond your own statement. The key to a successful lupus disability claim is to provide clear and consistent evidence that showcases the limitations and impact of your condition on your ability to work and carry out daily activities.
Medical Evidence for Lupus
Comprehensive and compelling medical evidence is the backbone to your lupus disability claim. Here are some important types of medical evidence you can submit to strengthen your lupus disability claim:
Medical records: Provide copies of all relevant medical records, including diagnoses, treatment history, and notes from appointments with your healthcare providers. This should include records from rheumatologists, internal medicine specialists, and any other healthcare professionals involved in your lupus care.
Hospitalization and emergency room records: If you’ve had to be hospitalized or visited the emergency room due to lupus-related complications, include these records to illustrate the severity of your condition.
Diagnostic test results: Include any laboratory test results that confirm your lupus diagnosis, such as antinuclear antibody (“ANA”) test, anti-double-stranded DNA (“anti-dsDNA”) test, complete blood count (“CBC”), erythrocyte sedimentation rate (“ESR”), and C-reactive protein (“CRP”) levels.
Treatment details: Submit information about the medications prescribed for lupus management, as well as their side effects, dosages, and frequency of use. Include records of any other treatments such as physical therapy or occupational therapy.
Physician statements: Obtain written statements from your treating physicians, particularly rheumatologists, who can describe the severity of your lupus symptoms, the frequency of flare-ups, and how they impact your ability to work and perform daily tasks.
Functional Capacity Evaluation: You may consider undergoing a functional capacity evaluation (“FCE”) in support of your lupus disability claim. The FCE will outline the limitations your lupus imposes on your physical abilities, such as mobility, standing, lifting, and fine motor skills.
Neuropsychological Evaluation: If you experience significant cognitive symptoms due to your lupus, consider a neuropsychological evaluation. A neuropsychological evaluation can provide objective and comprehensive evidence of cognitive impairments caused by the disease. The evaluation, conducted by a neuropsychologist, assesses various cognitive functions, such as memory, attention, problem-solving, and language abilities. The results of the evaluation can help validate and quantify your cognitive challenges, providing vital documentation that strengthens your claim and demonstrates the severity of the limitations caused by your lupus.
Additional Evidence for Lupus
While medical evidence may be the strongest you can use to support your claim, there are other types of evidence you can submit, including:
Vocational Evidence: Vocational evidence can include your resume, an official job description from your employer, work performance evaluations or written warnings that note any decline in your performance due to your lupus, and written statements from your employer and/or co-workers that testify to your job duties and how your lupus has affected your job performance. You may also consider undergoing a vocational assessment conducted by a vocational expert that details your material job duties and functional limitations.
Personal Statements: You may submit a personal affidavit in support of your claim. This affidavit should outline your educational and employment background, the onset of your lupus, and how your symptoms prevent you from working and performing other daily activities. Additionally, you may have a spouse, family member, or close friend also write a statement in support of your claim that shares how they have witnessed lupus affect your working and daily life.
Pain journal: Keep a journal to document your daily pain levels, fatigue, and other lupus-related symptoms. This can provide a detailed record of how your symptoms fluctuate and affect your ability to function over time. A detailed journal adds credibility to your self-reported subjective symptoms.
Photos and documentation of visible symptoms: While lupus is an invisible illness, if you experience visible symptoms like rashes or skin lesions, take photos of them and include them in your medical evidence.
Remember, if you’re unsure about the specific evidence required or need assistance in the claims process, consider consulting with a disability attorney who can guide you through the process and ensure you present a compelling case.
How Can The Maddox Firm Prove My Lupus Disability Claim?
At The Maddox Firm, we understand the hardships that those with lupus face when pursuing the disability benefits you rightfully deserve. Our experienced team specializes in guiding claimants through the intricate process of securing these short and/or long term disability benefits, offering much-needed support and expertise to navigate the challenges that lie ahead.
Here are some of the ways a long term disability lawyer at The Maddox Firm can help prove your lupus disability claim:
Examining Your Insurance Policy: The Maddox Firm can explain to you your disability insurance policy by providing a thorough examination of its terms and coverage details. We can clarify any ambiguous language, identify potential limitations or exclusions, and ensure you have a clear understanding of the benefits you are entitled to under the policy.
Expertise in ERISA Regulations: ERISA is a complex federal law that governs most employer-provided short and long term disability insurance plans. The Maddox Firm is well-versed in the intricate details of ERISA regulations, ensuring that your claim is handled according to the law and the specific terms of your disability insurance policy.
Combating Insurance Company Tactics: Insurance companies may use various tactics to deny or undervalue your lupus disability claim. The Maddox Firm understands the common strategies used by insurance companies and can anticipate and counter these tactics effectively.
Gathering and Organizing Evidence: The Maddox Firm will help you gather all the necessary medical and non-medical evidence to support your lupus disability claim. We ensure that your documentation meets the stringent requirements of your insurance company and strengthens your claim to the fullest extent possible.
Completing Paperwork and Deadlines: Filing a disability claim involves extensive paperwork and adherence to strict deadlines. The Maddox Firm will handle all the necessary paperwork, ensuring that it is correctly completed and submitted on time.
Communicating with Your Insurance Company: The Maddox Firm immediately takes over all communications with your insurance company on your behalf, advocating for your rights and making sure your insurance company adheres to the necessary deadlines.
Assisting with Appeals and Litigation: If your lupus disability claim is denied or disputed, The Maddox Firm can assist you in filing an appeal with the insurance company. We will help you gather additional evidence, prepare a strong appeal, and present persuasive arguments to support your claim. In the event that litigation becomes necessary, The Maddox Firm can help you sue your insurance company and represent you in court.
Whether you are looking for assistance in navigating the claims process, appealing a claim denial, or litigating a final adverse decision, The Maddox Firm can help with your lupus disability claim. The experienced team at The Maddox Firm will examine your insurance policy, correspondence from your insurance company, medical records, and any other relevant documentation in order to give you personalized guidance on how we can help you win your lupus short and/or long term disability claim.
Contact us to help you file your claim, appeal, or litigation the right way.